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目的评估泌尿系感染不同管理策略的效果。设计随机对照试验。措施初级保健。受试者309例非妊娠、年龄18~70岁的可疑泌尿系感染女性。干预将患者随机分组,采取5种管理方法:经验性用抗生素;经验型延迟(48 h)用抗生素;或依据症状评分用靶抗生素(尿液混浊、尿臭、夜尿症或排尿困难,≥2项),浸渍检测(亚硝酸盐或白血球和血),或中段尿分析结果阳性。每组均做了自助控制。主要结果测量症状严重度(2~4 d)和持续时间,抗生素使用情况。结果若立即用抗生素,患者感觉坏症状为3.5 d。症状持续时间或严重性无显著差异(在0~6刻度范围内平均症状频率:即刻用抗生素2.15、中段尿2.08、浸渍检测1.74、症状评分数1.77、延迟用抗生素2.11、5组似然比检验P=0.177)。用抗生素(即刻用抗生素97%、中段尿81%、浸渍检测80%、症状评分90%、延迟用抗生素77%;P=0.011)和送中段尿标本(即刻抗生素23%、中段尿89%、浸渍检测36%、症状评分33%,延迟用抗生素15%;P<0.001)存在差异。患者至少等48 h才开始用抗生素,再做咨询的较少(HR 0.57[95%CI(0.36,0.89),P=0.014],但与即刻用抗生素者相比,症状持续的时间要长[发生比率1.37(1.11~1.68),P=0.003],尤其中段尿组[长73%,22%~140%;其他组无持续时间>22%]。结论所有管理策略都达到了控制症状类似效果,送中段尿标本检测未表现出其优势,靶抗生素浸渍检测与延迟用药作为替代方法,或经验性延迟用药有助于减少抗生素使用。
Purpose To assess the effectiveness of different management strategies for urinary tract infection. Design randomized controlled trials. Measures for primary care. 309 subjects were non-pregnant, aged 18 to 70 years of suspected urinary tract infection in women. Interventions were randomized to five management approaches: empirical antibiotics; empirical delayed (48 h) antibiotics; or target antibiotics (urine cloudy, urine stink, nocturia or dysuria ≥ 2 based on symptom score ), Immersion test (nitrite or white blood cells and blood), or positive urine test results. Each group has done self-control. The main results measure the severity of symptoms (2 to 4 days) and duration of antibiotic use. Results Immediately with antibiotics, the patient feels bad symptoms for 3.5 d. No significant difference in duration or severity of symptoms was observed (mean symptom frequency at 0-6 scale: 2.15 for immediate antibiotics, 2.08 for middle urine, 1.74 for impregnation, 1.77 for symptom score, 2.11 for delayed use of antibiotics, P = 0.177). Antibiotics (immediate antibiotic 97%, middle urine 81%, impregnation test 80%, symptom score 90%, delayed antibiotic 77%; P = 0.011) and sent to the middle of the urine samples (immediate antibiotics 23% Impregnation test 36%, symptom score 33%, delayed use of antibiotics 15%; P <0.001). Patients started antibiotics for at least 48 hours and did less counseling (HR 0.57 [95% CI (0.36,0.89), P = 0.014], but the duration of symptoms persisted for longer than immediate antibiotics [ (1.11-1.68, P = 0.003), especially in the middle urine group (73% longer and 22% -140% longer than any other group), and 22% longer in the other groups.Conclusion All management strategies have achieved similar effects as control symptoms , Urine samples sent to the middle of the test did not show its superiority, target antibiotic impregnation detection and delay medication as an alternative method, or empirical delay in medication helps to reduce the use of antibiotics.